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HomeMy WebLinkAboutPermit Plumbing 2013-7-29 SPRINGFIELD- . 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 „a, C Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 . Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01704 www.springfield-or.gov permitcenter @spnngfield-or.gav PROJECT STATUS: Issued ISSUED: 07/29/2013 EXPIRES: 01/24/2014 . STATUS DATE: 07/29/2013 APPLIED: . 07/29/2013 . SITE ADDRESS: 2551 37TH ST,Springfield,OR 97477 SCOPE: Plumbing Only ASSESOR'S PARCEL NO: 1702194208600 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Backflow device for Irrigation System OWNER: BEAGLE WYMAN 0 8 EDNA J Phone Number: ADDRESS: 2551 N 37TH ST SPRINGFIELD OR 97477 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone . Plumbing Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED . II Inspections 3620 Backflow Device Backflow Device: Prior to covering and provide a copy of the test report on site at the time of inspection. By signature, I state and agree,that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street,that the permit card is located at the front of the property,and the approved set of plans will remain on the site at all times during construction. .. ////////J —r s7;i..../G/ j-� �� z s■ Owner • Contractor Signature / Date • ATTENTION: Oregon law requires you to NOTICE: SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001- COiNMENCED OR IS ABANDONED FOR 009 You may obtain copies of the rules by ANY 180 DAY PERIOD. calling ing the center. (Note: the teleph:::=;o number the Center is 1-800-332-2344). Oregon Notification Springfield Building Permit 7/29/2013 10:42:14AM Page 1 of 1 SPRINGFIELD '- CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Spnngield,OR 97477 541-726-3753 oaeaoN 811-SPR2013-01704 ,v.spdngied-ar.gov 2551 37TH ST permilcenter©springfield-or.gov RECEIPT NO: 2013001648 RECORD NO:811SPR2013-01704 DATE:07/29/2013 DESCRIPTION c al,t34,k. iA.. AGCOUNT'CODE/TRANSCODE .'.:. rMs"'AMOUNT'DUE:�? Backflow preventer 224-00000-425603 1005 21.00 Balance of Minimum Plumbing Permit Fees 224-00000-425603 1005 59.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 PAYMENTHTVPE P-AYOR ei IER ccpRFER gii. COMMENTS ._ AMPIM fiAlD Credit Card BEAGLE WYMAN 0& EDNA J 93.60 004736 TOTAL PAID: 93.60 c Plumbing Permit Application DEPARTMENT USE ONLY SPRINGFIELD kiiii: /CITY OF SPRINGFIELD, OREGON Permitno.: Gqj� —I Q`/ 225 Fifth Street• Springfield,OR 97477•PH(541)726-3753 •FAX(541)726-3689 Date: 7//��//5 This permit is issued under OAR 918-780-0060.Permits are issued only to the person or contractor doing/the work.Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑Yes ❑No Description Qty,_ Cost Total ea cost Sanitation approval verified? ❑Yes ❑No New residential 0/Residential OF CONSTRUCTION I bathroom/I kitchen(includes:first Uv Residential 100 feet of water/sewer lines, hose El Government ❑Commercial bibs, ice maker,underfloor low-point $238.00 $ JOB SITE INFORMATION AND LOCATION drains and rain-drain packages) Job site address: ',55 7 3 7 -R'� 2 bathrooms/] kitchen $374.00 $ 1 3 bathrooms/I kitchen $439.00 $ CitY5 ri V c-,.a(d State:© C ZIP: 7�7 P Each additional bathroom(over 3) $95.00 $ Reference: /17Q 2 Q Z Taxlot . 96 0 0 Each additional kitchen(over I) $95.00 $ DESCRIPTION OF WORK -� .1 Residential fire sprinklers(includes plan review) S✓)R t l./� le_ Si,/STS' m I �.S I A I I R-'I o L) 0 to 2,000 square feet $58.00 $ T 2,001 to 3,600 square feet $116.00 $ PROPERTY rOWNEgR 3,601 to 7,200 square feet $174.00 $ Name: o) m A A l3SfT I c: 7,201 square feet and greater $232.00 $ 14. Manufactured dwelling or pre-fab(circle one) Address: oZ6-S/ .� ( Connections to building sewer and $58.00 $ Citysr(� �� Stale:©� ZIP:97`� 7 7 water supply Commercial,industrial,and dwellings other than one-or Phone: - - /l-7` -R(570 Fax: - - two-family E-mail: c�(na /0066) L; Jp. LOYv) Minimum fee $58.00 $ This installation is being'made on residential or farm property Each fixture $19.00 $ owned by me or a member of my immediate family,and is Miscellaneous fees exempt from licensing requirements under OAR 9 695-0020. 100' storm,sewer,water line $76.00 $ Signature:' Each fixture,appurtenance,and piping $19.00 $ CO CTOR INSTAL TI N Storm water retention/detention facility $19.00 $ / Business name: 9—j/(�"_. Irrigation systems $19.00 $ ✓ Piping or private storm drainage $19.00 $ . Address: systems exceeding the first 100 feet City: State: ZIP: Specialty fixtures $19.00 $ Reinspection(no.of hrs.x fee per hr.) $58.00 $ Phone: - - Fax: - - Special requested inspections(no.of E-mail: hrs.x fee per hr.) $58.00 $ CCB license no.: BCD license no.: Each additional inspection:(1) $58.00 $ Plumbing license no.: Medical gas piping Minimum fee $ Print name: Enter value of installation and equipment$— Enter fee based on installation and equipment value. $ Signature: APPLICANT USE (A) Enter subtotal of above fees $ OD (Minimum Permit Fee$58.00) (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 x[A+B]) $ 2'6_9 (ID)Technology Fee(5%of[A]) $ (add TOTAL fees and surcharges(A through D): $e7?“' 440-2500-1(11/08/COM)